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A Collection of Medical & Legal Information About Brain Injury

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The New Truths about Traumatic Brain Injury (TBI)

Over the course of the last twenty years, many previously accepted schools of thought with regard to the study of traumatic brain injury ("TBI") have been proven false or substantially revised. Unfortunately, litigants presenting TBI/brain injury cases are too often "assessed" by insurance company physicians who are inevitably unaware of the sea changes in the field. Many of these physicians, as well as insurance companies, will try to assess your injury via 1990 medicine rather than what is known today. Below are just some of the examples that serve as red flags that a brain injury/TBI claim is being improperly and inadequately assessed:

No loss of conscious equals no injury: FALSE

Twenty or thirty years ago, in the "dark ages," it was assumed that without a frank episode of loss of consciousness, no permanent or serious TBI could have occurred in humans. We now know this is not true. For example, we represented a client who was shot in the forehead with a 22-caliber rifle, yet never lost consciousness. The gentleman nevertheless sustained severe brain injury. A mere "alteration" or diminishment of consciousness may be a clear indicator of brain injury. With all that is happening both during and in the time immediately after an accident, it is often difficult to determine if someone indeed lost consciousness, and a person driving alone, or who suffers an injury when no one else is around, often has no way of recollecting a loss of consciousness. This is especially true when they are shaken or otherwise spoken to in the aftermath of a collision or fall. Examples of an "alteration of consciousness" include:

Seeing stars;
Being unable to recall a loved one's phone number;
Not knowing how to tell someone where the accident occurred;
Inappropriate speech; "Missing time" - reflect very carefully upon how things occurred before and after the accident and often times in retrospect there can be missing time which is equivalent to LOC; Amnesia - amnesia is slightly different from LOC in that the amnesia can extend for longer periods both before and after the accident (retrograde and interior grade amnesia).

A separate problem arises when a loss of consciousness is inappropriately denied to emergency medical personnel-that that information is relayed to the emergency room staff, and becomes a "truth" to be dealt with throughout the life of the case, as well as greatly affecting the patient's course of treatment.

Keep in mind that a large businesses such as store or hotels, (or any defendant really), may delay calling for emergency medical response, so that upon their later arrival, the injured person is conscious and doing better, thus weakening the plaintiff's case. If possible, you should take a picture or video of the person unconscious in the vehicle or on the floor, as a picture is worth a thousand words, provided this can be done, without endangering the health of the individual.

Diffuse Axonal Injury: How the brain is injured

In the old days there was no term for "Diffuse Axonal Injury" ("DAI"), which is now known to be the main process by which the brain is injured. "Diffuse" refers to widespread damage in the brain from trauma, as opposed to injury confined to one area, so called "focal injury". As an example, the difference between falling off of a motorcycle at 45 miles per hour versus getting hit in the forehead with a hammer - the former would develop widespread injury while the later would generally be located at the area of the brain closest to the direct blow. Unfortunately, diffuse injuries are far worse, since they require widespread healing rather than local or focal healing. Think of a relative who has had a stroke, which is a very focal but serious injury. With rehabilitation the brain can work around that injury in a process known as "plasticity." So we do see dramatic improvements in most strokes, but not in most DAI injuries.

It was also previously thought that DAI only occurred in the context of a coma or a severe TBI. That is no longer a true statement, as DAI has been shown to be the signature injury in the mild TBI's found in returning soldiers who were exposed to a blast.

Pediatricians say the very young do better than others with TBI: FALSE

Several years ago, there was a study done with primates which indicated that younger chimpanzees fared better than adults with TBI. However, more recent studies have debunked this finding, clearly demonstrating that TBI to an infant or young child causes greater and more lasting injuries and symptoms than the equivalent with an adult. This is because the infant and child brain is not fully developed until 23 or 24 years old and if the architecture of the growing brain is laid down improperly due to injury, it creates long lasting effects that last throughout the affected person's life.

Anxiety and depression are not part of TBI: FALSE

For many years there has been a strict medical differentiation between "psychological symptoms" and "organic symptoms" of TBI. However, as modern medicine has shown us, ALL psychological states are organically and neuro-chemically caused. This is especially true for anxiety and depression which are very common conditions created or exacerbated by TBI. They are real organic conditions, not some type of adverse "feeling" without a biological origin.

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TBI is an acute injury only: FALSE

This is a major misconception which has only recently been addressed. We will talk about this in more detail later, but the idea that a TBI is at its worst shortly after an event is untrue. There is ample research to show that in many ways, TBI is a chronic, decades-long illness, rather than something that goes away in a month.

No seizures with mild TBI: FALSE

Again, studies on returning soldiers have shown that post traumatic seizures occur with mild TBI as well as severe, or moderate TBI.

I had a previous concussion so that ruins my case: FALSE

Many lawyers will decline a case when they find out that a client suffering a TBI had suffered a TBI in the past, when in fact, that type of history is meaningless. We know that with each successive concussion, that event becomes harder to recover from and will present worse symptoms than in one without history of TBI. A prior TBI is not an issue unless it resulted in appreciable cognitive symptoms in the person up to the time of the more recent injury. Usually this is not the case, and it can easily be shown that the person was functioning normally at work and at home despite, for example, a history of concussion, but that following the subject injury, they are doing more poorly because of that history. A defendant must "take you as they find you."

Therefore, if a lawyer in your case or a treating physician or defense doctor is judging your situation with antiquated medical knowledge and dismissing the severity of your injury, you need to contact us.

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